Parent / Guardian Info

Emergency Contact

Bunk Mate Choice

WE DO OUR BEST TO PLACE YOU WITH AT LEAST ONE OF YOUR REQUESTED BUNK MATES!

Bunk Choice #1

BUNK CHOICE #1

FirstLast

Bunk Choice #2

BUNK CHOICE #2

FirstLast

Medical Info

Health Insurance Company*

Policy Number*

Group Number*

Insurance Claims Address

Street AddressAddress Line 2CityStateZIP Code

Subscriber’s Name*

SUBSCRIBER'S NAME

FirstLast

Does your camper have allergies?*

Yes

No

Please note: Unfortunately, our ability to accommodate food and dietary allergies is limited. Our administrative staff has no control over the food or menu selection. The camp facility is rented from Sky Mountain Camp and their organization provides the meals and does not receive requests and/or accommodate dietary restrictions/allergies.

Please initial in agreement and acknowledgement of the above statement.*

Please list all allergies*

Does your camper have sensory processing issues?*

Yes

No

Please note: In general, as a teen camp, the camp can be loud and overwhelming to those who are sensitive to noise and light. Please let us know how we can best assist your student in having a great time at the camp.

Please list how we can best assist your student during sensory overload:*

Does camper carry an EPI-Pen?*

Yes

No

Is the camper undergoing treatment for any condition?*

Yes

No

Please list treatment(s) and for what condition(s)*

Does the camper take any medications?*

Yes

No

Please list any and all medications including instructions and doses.*

Cell Phone Agreement

Our camp is a CELL PHONE FREE environment. We ask each student to leave their phone at home or the cell phone will be held by the youth leader for the week and returned upon arrival back at your home church. There is a pay phone (you will need quarters) if you would like your student to contact you through the week. We agree to contact you to tell you if your child is experiencing a challenge in their adjustment to camp. You can help by talking with your camper before they leave for camp and tell her that there is always someone they can reach out to, whether her counselor or the camp director.
You are also welcome to contact your youth pastor to check in on your camper’s adjustment. Other electronic items, such as iPods/MP3/Kindles/Tablets of any kind are not allowed at camp.

Please initial in agreement with the above statement.*

Waiver Release

Camper has permission of the undersigned to participate in any or all camp activities of the year 2019. In the event of an emergency affecting the health or welfare of my son/daughter, I do give permission for the counselors, EMT or camp staff to administer first aid and/or transport him/her to the nearest doctor or hospital for further medical attention as deemed necessary. The persons acting in response to such emergency will be held blameless.
In the event medical expenses occur, they will be borne by the parents or the guardians of the student. Insurance afforded by the Wesleyan Camp is excess insurance over any and all valid collectible insurance coverage available for your child.